The Patterns Of Care Study For Operable Gastric Cancer In A Single Hospital And References Review

Objective: Inguinal hernia is one of the most common diseases in general surgery.Laparoscopic is a common treatment for repairing inguinal hernia.This paper evaluated laparoscopic totally extraperitoneal prosthesis(TEP)and transabdominal preperitoneal(TAPP)in several aspects such as operation duration,postoperative pain,postoperative recurrence,and postoperative complications by comparison study and data analysis.Thus,this paper can provide more scientific,reliable,and reasonable evidences in the clinical decision-makingMethods: By setting strict standards and exclusion criteria to retrieve the database such as Pub Med,Cochrane Controlled Trials Register,Wanfang,and Vip,we collected the randomized controlled trials(RCTs)about comparing the clinical efficacy between TEP and TAPP for treating original inguinal hernia.Cochrance collaboration’s tool for assessing risk of bias was used to evaluate the quality of the retrieved literatures,and Revman5.0 software also was used to evaluate the system quantitatively.At last,Begg’s were used to estimate the publication bias by testing regression equation and calculating the fall-safe number.Results: There were seven RCTs(18760 patients)analysed,which include 11,293 TAPP cases and 7,467 TEP cases.Compared with TAPP group,the operation duration of TEP group was shorter(OR=4.96,95%CI,[4.36,5.57],P<0.00001),and the difference was statistically significant.After TAPP,hematoma was more likely to occur(OR=2.93,95%CI,[2.32,3.70],P<0.00001),and the difference was statistically significant.Compared with TEP group,postoperative hospitalization of TAPP group was 0.10 d longer(95%CI,[0.06-0.14],P<0.00001),and the difference was statistically significant.According to the results,the combined effects of related incidences are as follows: postoperative pain(OR=2.75,95%CI,[1.21-6.23],P=0.02),postoperative recurrence rate(OR=0.70,95%CI,[0.15-3.18],P=0.85),wound infection rate(OR=1.34,95%CI,[0.40-4.54],P=0.64),the urinary retention(OR=0.90,95%CI,[0.43-1.89],P=0.78),hematoma formation(OR=2.93,95%CI,[2.32-3.70],P<0.00001)and effusion formation(OR=2.04,95%CI,[0.97-4.29],P=0.06).It can be concluded that postoperative pain of TEP was lighter than TAPP,while the incidence of hematoma of TEP was also lower,and the difference was statistically significant.However,there were no significant differences between TEP group and TAPP group in other related indexes.Conclusion: Conclusions: Compared to the pain level,the TEP group was lighter than the TAPP group.And the TAPP group has the higher probability in hematoma and seroma.There were little differences in operative time,postoperative recovery,postoperative recurrence,urinary retention and wound infection between TAPP group TEP group.In the future,more high quality RCTs with large sample size are needed to confirm the differences between TAPP and TEP.